Risk factors for adverse fetal outcomes among women with early- versus late-onset intrahepatic cholestasis of pregnancy

Abstract Objective To determine risk factors for adverse fetal outcomes (AFOs) among women with intrahepatic cholestasis of pregnancy (ICP) on the basis of time of onset. Methods In a retrospective analysis, data were obtained for all women with ICP admitted to two centers in Guangzhou, China, between February 1, 1993, and January 31, 2014. Patients were divided into group A (early-onset ICP) and group B (late-onset ICP), and were further divided on the basis of severity. The frequency of AFOs was assessed. Results Among 371 eligible women, 57 (15.4%) were in group A and 314 (84.6%) in group B. AFOs affected 20 (35.1%) women in group A and 67 (21.3%) in group B ( P = 0.024), and 12 (54.5%) of 22 women in group A and 21 (29.6%) of 71 in group B with severe ICP ( P = 0.032). Independent risk factors for AFO in group A were increased levels of serum bile acid ( P = 0.016) and alkaline phosphatase ( P = 0.004). Independent risk factors in group B were increased levels of alkaline phosphatase ( P < 0.001) and gamma-glutamyl transpeptidase ( P = 0.001). Conclusion Early-onset ICP is associated with a higher frequency of AFO than is late-onset ICP, especially in severe disease. The risk factors differ between early-onset and late-onset ICP.